Methods  •  Retrospective  patient  information  (n=25)  was  collected  which  included  the  following:  age  at  diagnosis,  gender,  tumor  site,  tumor  stage,  height  and  weight,  and  enteral  nutrition  information  (if  applicable).  Of  the  25  records  reviewed,  5  did  not  contain  tumor  stage  and  7  did  not  include  height.    

•  Weight  change  over  the  5-­‐week  period  was  calculated  by  subtracting  starting  weight  from  ending  weight,  measured  in  kilograms.    

•  Percent  weight  change  was  calculated  by  dividing  weight  change  in  kilograms  by  starting  weight  in  kilograms  and  multiplying  by  100.    

•  The  statistical  package  for  Excel  2011  for  Mac  StatPlus:  Mac  LE  (Build  6.0.3)  was  used  for  all  statistical  analyses.    •  A  sample  means  t-­‐test  was  used  to  examine  the  statistical  signiRicance  of  the  observed  weight  change.    •  Multiple  linear  regression  was  used  to  examine  the  strength  of  relationship  between  predictors  –  age,  gender,  tumor  site  –  and  the  response  variable  –  percent  weight  change.    

•  A  p  value  of  <0.05  was  considered  statistically  signiRicant  for  all  statistical  analyses.  

Impact  of  Squamous  Cell  Carcinoma  of  the  Head/Neck  on  Weight  Status    Abigail  R.  Smith  

 UK  DHN  CP  Class  2016  Research  Mentor:  Aaron  Schwartz,  MS  RD  LD  

Abstract  The  purpose  was  to  examine  the  impact  of  diagnosis  and  treatment  of  squamous  cell  carcinoma    of  the  head/neck  (SCCHN)  on  weight  status  over  a  5-­‐week  period.  A  sample  of  25  SCCHN  patients  treated  with  radiation  therapy  for  a  minimum  of  5  weeks  was  retrospectively  analyzed.  Comparison  of  the  mean  weight  change  over  the  5-­‐week  period  did  not  yield  statistically  signiRicant  results  (p=0.72).  The  average  weight  loss  over  5  weeks  was  3.12%  (2.38  kg).  Multiple  linear  regression  examining  the  association  between  explanatory  variables  –  age,  gender,  tumor  site  –  and  the  response  variable  –  percent  weight  change  –  explained  13.44%  of  weight  change  in  this  population  (R2  =0.13442).  Each  additional  year  of  age  was  associated  with  a  0.087%  weight  loss  (p=0.13).  Men  were  associated  with  2.19%  less  weight  loss  over  5  weeks  than  women  (p=0.38).  Oral  tumor  site  was  associated  with  a  3.05%  greater  weight  loss  over  5  weeks  when  compared  to  other  tumor  H/N  tumor  sites  (p=0.058).  Though  results  did  not  reach  statistical  signiRicance,  this  study  suggests  substantial  clinical  implications.  Data  regarding  the  anticipated  average  weight  loss  and  risk  factors  for  increased  weight  loss  in  HNC  patients  could  be  used  to  guide  healthcare  professionals  and  caregivers  in  choosing  an  optimal  prophylactic  nutrition  strategy.    

Hypothesis  Individuals  diagnosed  with  and  treated  for  squamous  cell  carcinoma  of  the  head/neck  (SCCHN)  will  experience  signiRicant  weight  loss  within  the  Rirst  5  weeks  of  treatment  with  radiation  therapy.     Objectives  To  measure  the  average  weight  change  of  individuals  treated  for  SCCHN  within  the  Rirst  5  weeks  of  treatment  with  radiation  therapy  and  to    identify  risk  factors  for  increased  weight  loss  within  this  population.  

Results  •  An  examination  of  weight  change  over  the  5-­‐week  treatment  period  did  not  yield  statistically  signiRicant  results.    

•  The  average  weight  change  in  the  5-­‐week  period  was  a  loss  of  2.38  kg.    

•  The  average  percent  weight  loss  was  3.12%.    •  The  sample  means  t-­‐test  for  comparing  the  mean  starting  and  ending  weight  (kg)  resulted  in  a  p  value  of  0.72.    

•  Multiple  linear  regression  examining  the  association  between  explanatory  variables  –  age,  gender,  tumor  site  –  and  the  response  variable  –  percent  weight  change  –  explained  13.44%  of  weight  change  in  this  population  (R2  =0.13442).    

     

Discussion/Conclusions  •  The  observed  results  were  in  agreement  with  current  research.  Patients  undergoing  treatment  for  SCCHN  experience  weight  loss1,2.  Female  gender  and  oral  tumor  site  were  risk  factors  associated  with  increased  weight  loss  in  SCCHN  patients3.  

•  Future  studies  with  a  larger  sample  size  and  an  expanded  research  design  that  allows  access  to  more  complete  patient  information  as  well  as  a  timeline  that  allows  researchers  to  follow  patients  during  and  after  treatment  may  yield  statistically  signiRicant  results.  

•  Although  the  observed  weight  change  was  not  statistically  signiRicant,  it  is  clinically  signiRicant.  There  was  a  3.12%  observed  weight  loss  in  5  weeks  compared  to  the  deRinition  of  cachexia  which  is  5%  weight  loss  in  3-­‐12  months4.  

•  Data  regarding  the  anticipated  average  weight  loss  and  risk  factors  for  increased  weight  loss  in  HNC  patients  could  be  used  to  guide  healthcare  professionals  and  caregivers  in  choosing  an  optimal  prophylactic  nutrition  strategy  based  on  the  presence  or  absence  of  these  risk  factors.    

References  1.  Platek,  M.  E.,  Myrick,  E.,  Mccloskey,  S.  A.,  Gupta,  V.,  Reid,  M.  E.,  Wilding,  G.  E.,  .  .  .  Singh,  A.  K.  (2013).  Pretreatment  weight  status  and  weight  loss  among  

head  and  neck  cancer  patients  receiving  deRinitive  concurrent  chemoradiation  therapy:  Implications  for  nutrition  integrated  treatment  pathways.  Supportive  Care  in  Cancer,  21(10),  2825-­‐2833.  doi:10.1007/s00520-­‐013-­‐1861-­‐0    

2.  Silver,  H.  J.,  Guimaraes,  C.  D.,  Pedruzzi,  P.,  Badia,  M.,  Carvalho,  A.  S.,  Oliveira,  B.  V.,  .  .  .  Pietrobon,  R.  (2010).  Predictors  of  functional  decline  in  locally  advanced  head  and  neck  cancer  patients  from  South  Brazil.  Head  Neck  Head  &  Neck,  32(9),  1217-­‐1225.  doi:10.1002/hed.21322    

3.  Zhao,  J.,  Zheng,  H.,  Li,  L.,  Zhang,  L.,  Zhao,  Y.,  &  Jiang,  N.  (2015).  Predictors  for  Weight  Loss  in  Head  and  Neck  Cancer  Patients  Undergoing  Radiotherapy.  Cancer  Nursing,  38(6).  doi:10.1097/ncc.0000000000000231    

4.  Von  Haehling,  S.,  &  Anker,  S.  D.  (2010).  Cachexia  as  a  major  underestimated  and  unmet  medical  need:  facts  and  numbers.  Journal  of  Cachexia,  Sarcopenia  and  Muscle,  1(1),  1–  5.  http://doi.org/10.1007/s13539-­‐010-­‐0002-­‐6      

2

2

82.54  

80.16  

78.5  79  

79.5  80  

80.5  81  

81.5  82  

82.5  83  

Starting  Weight   Ending  Weight  

Weight  (kg)  

Figure  2:  Comparison  of  average  starting  and  ending  weights  

Design  A  retrospective  observational  study  was  used  to  collect  data  for  review.  Patients  diagnosed  with  an  oral  or  throat  squamous  cell  carcinoma  tumor  and  treated  with  radiation  therapy  for  a  minimum  of  5  weeks  at  the  time  of  data  collection  were  eligible  for  this  review.    Setting        Data  collection  took  place  in  the  Radiation  Medicine  Department  at  a  community  cancer  center  in  Central  Kentucky.  

Figure  1:  High  power  view  of  squamous  cell  carcinoma  malignancy